- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $986.20 / $4,783.50 / $9,524.47
| Facility | | $986.20 | $4,783.50 | $9,524.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,802.34 / $8,315.66 / $18,150.00
| Facility | | $3,802.34 | $8,315.66 | $18,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $937.50 / $937.50 / $2,308.02
| Facility | | $937.50 | $937.50 | $2,308.02 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $81.50 / $81.50 / $81.50
| Facility | AS | $81.50 | $81.50 | $81.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $8,273.00 / $14,705.00
| Facility | | $4,062.00 | $8,273.00 | $14,705.00 |